Haiti Earthquake Blog

26.4.2010:

Port-au-Prince, Haiti It is three months since the earthquake hit
Haiti. The Palace, which is the national symbol of Haiti, is being
demolished. Nevertheless, people are slowly beginning to clear the
rubble and start rebuilding their homes. At the general hospital in
Port-au-Prince, the patients are being moved into buildings as the
ward tents come down. However those same patients are still
terrified of earthquakes and fear a concrete 'hospital grave'.
We'll work with the patients and try and calm their fears.

Thankfully we’ve moved out of the tents
ourselves at International Medical Corps Haiti. This was a great
relief to me but the tents are never far away for us in case we
stop trusting the buildings. Our mental health work continues to
make good progress. We're embedded in several primary care clinics
in Port-au-Prince and the surrounding earthquake affected areas,
intensively training staff and supervising the mental health
clinics.

The clinics are mainly still based in
tents. It’s an uncomfortable, hot environment for the staff who
work day in, day out. We still see a great variety of patients -
mainly those suffering palpitations and anxiety. Many had these
symptoms at the beginning of the earthquake and they have
intensified because they fear another earthquake will happen. We
don’t see post-traumatic stress disorder. I have only seen one case
which was a girl kidnapped and badly assaulted two years prior to
the earthquake. There, however, remains a universal earthquake
anxiety.

Everyone has a fear of being indoors are ready to escape at
short notice. Often people don’t know what to do. When I asked a
child at the clinic, he replied that he would cry then pray; he
didn’t think of safety. There is a surge of cases of SGBV or sexual
and gender-based violence. At my clinic yesterday I saw a 13 year
old girl with her parents after her rape. She said she was fine but
she looked incredibly sad and is afraid of any man coming near her.
She has to start school now and try and get back to normal. The
parents have explained the situation to the school but the girl has
decided not to tell her friends. Another casualty of the earthquake
is a young girl of 12 who keeps running after women in the street
who look like her mother. Her mother died in the earthquake and
this girl did not get to go to the funeral. She doesn’t believe she
is dead - another casualty of the earthquake. Today a man arrived
and asked us to take care of his daughter. She is 4 years old. She
may have been abused when he left her with neighbours. He took the
child away when he realised this. However, he can’t work and
support the child at the same time. The mother is mentally ill and
unable to care for her. He begged us to take care of the child.

This is just one of a number of cases of people asking us to
take their children as they can’t support them any more. There are
countless stories of loss of children, wives and husbands every day
in the mental health clinic and at the hospital. On the other hand
we are reaching people with mental health problems who would never
have had treatment without the earthquake. What we have done is
provide treatment to those who were previously marginalised and
stigmatised. Illness has been aggravated by the earthquake. Indeed
life in every way is prisimed through the earthquake. We conduct
lively training programmes for the primary care health staff. A
recent talk by Father Pierre Eustache was particularly well
received. He described how Haitians can symbolically have a
formalised mourning ritual for those that are lost, including those
whose bodies have never been recovered. This training had a strong
resonance with the staff. I realised then how many had been
directly affected by the earthquake, with loss of loved ones, home
and jobs.

I am coming to the time when I originally planned to return to
UK. I can’t deny counting the days if not the hours of my return.
On reflection, I have enjoyed the work although it has been hard
and frustrating. At times I have been burned out and totally
exhausted. I have probably cracked up on many occasions. However,
there is a sense that there is a long standing benefit from our
presence in terms of mental health; certain people have received
treatments who wouldn’t have done otherwise. There are definately
Haitian health professionals I know who now carry knowledge of
mental health treatment with them, and can make a difference to
those with mental health problems in the future. I have been proud
to be part of this work. So instead of leaving Haiti for good, I
will return after a brief break in UK and continue for a while
longer on this programme with International Medical Corps in Haiti.
The scale of the destruction, lack of an existing mental health
system in the country and the dire poverty of Haiti means there is
a lot of work ahead for the future for all those who come here from
overseas and from Haiti.

Like hundreds of Haitian entrepreneurs,
I was greatly affected by 12 January’s very deadly earthquake.
Listening to a Haitian evangelical radio station, waiting for
two visitors while taking a nap in my cosy little office at the
Haitian Environmental Reporters Network (REHPE), I heard some
weird noise and felt some strong vibration which lasted about
thirty seconds. In fact, I thought that my office building
was collapsing from exhaustion because it was very old - some 120
years old. It usually shook up whenever a big car or truck
passed by. All of a sudden, I had an idea firmly rooted in my
mind to exit my place by jumping out of the first storey, with my
bare feet, which I did! Being on the first floor, I
was questioning my business colleagues about what happened. They
told me that it was an earthquake.

Everybody was shouting, especially women
not being able to control their emotions. A wide mass of dust
filled in the air. People became dirty. They looked ugly with grey
powder finely spread over their faces, heads and bodies. It
was a big disaster. Several houses, schools and state buildings in
my area were destroyed. With a lot of caution, a few minutes
later, I had decided to re-enter my still-standing work place to
rescue some important materials such as electronic items, office
supplies, files etc… Fortunately, I was by myself in my
office. All my employees had already left. So I could feel guilty
if one of them had to die or be hurt because of me.

On my way back home, I was just counting corpses, running
people, demolished residences and broken vehicles. My soul was
quite invaded by dismay, anguish, anxiety and fear.

Unlike my office building, my house was not affected by the
quake because it was built on the rock – in the mountain.

Losing my agency, my job, some close friends - and feeling sorry
for many people, I had to cope anyway with my new living condition.
Luckily, I had joined as an interpreter, guide and assistant in the
Mental Health Department of the International Medical Corps (IMC),
a well-known organisation which came to Haiti for the International
Disaster Relief Team / Haiti Emergency 2010 program. Hence, I met
Dr Peter Hughes, one of my supervisors, an Irish psychiatrist based
in London who had politely asked me to write this article for his
blog. Meanwhile, I have been looking for assistance to re-establish
my business organisation – which is just a pain in the neck!

Finally, as an Environmental journalist, it is obvious that the
12 January natural disaster had completely turned Haiti upside
down. The thinking and acting way of the Haitian people along with
their international good friends and sponsors must change by
developing a new sense of responsibility in future.

The quake had publicly unveiled the nudity of Haitians and their
foreign partners. Nothing really important has been done in Haiti
for the last 206 years such as a lack of a good infrastructure
system, no project had been implemented with a long-lasting
development and management goal and so on...

Of course, Haitians cannot help themselves. Billions of dollars
have been spent in Haiti. Nevertheless, for decades, the islanders
have been splashing around an awful misery under the monitoring
and/or with the agreement of their international fellows. Let’s say
that on the one hand, Haiti has always been located in a very
troublesome ecological region. Thus, the earthquake was just a fact
– not an event! Awareness was raised and warnings were given by
many specialists from different skylines.

Since last year, the Haitian Environmental Reporters Network
(REHPE) has been carrying out an Environmental Education Campaign
throughout the country for which it has gotten no support of any
kind! On the other hand, we can only count the days we are living
on the island. So wisdom is a must – what about common sense?

24.2.2010 General Hospital

It is now over a month since the earthquake. We have just had
the three days of mourning here in Port-au-Prince. The flags have
now gone up again throughout Haiti. There is normality now to daily
life. Walking past and over the rubble, and getting used to the
tent life of almost everyone and still an even greater number with
no shelter. The General Hospital has less and less
earthquake-related injuries and more everyday gunshot wounds, which
were a feature of Haiti life before, unfortunately. We have had a
few recent quakes in the past few days. Further bits of buildings
crumble and fall.

We went to the inpatients at the General Hospital. There are
many stuck inside a building and immobile. They were all very
scared of further quakes and the roof falling in on them but at the
same time were very stoical and gracious. Just as we were about to
start to think of returning to buildings the quakes have held us
back. I have managed to sleep through every quake so far and seem
oblivious, even when everyone else is running out of buildings!
That’s something I’ve got to change! For anyone who has experienced
the earthquake, they seem primed here to feel an intense visceral
fear and run out of buildings as fast as they can. Normality also
returns with rubble clearing. This may well expose more of the
corpses.

Local people are trying to salvage anything they can - metal,
wood. What is most alarming is people going into the ruins of a
huge market in Port-au-Prince as in the picture. There is a central
hall which has multiple floors of pan caked building above it. Yet
these children and adults risk their lives every day going in to
see what they can find.

Clinical

We are seeing a lot of patients who have an anxiety and
somatisation state. They are fearful since the earthquake and fear
being in any building. We see many manifestations of this with
cases of chest pain, palpitations and headaches.

Today I saw an adult male who clearly had autism, although never
diagnosed. The family are on the streets since the earthquake. With
the change of routine and the stress he has started to bite himself
severely on his body, causing severe self-inflicted wounds.

There are a lot of people, women particularly, who have gone
mute since the earthquake. I still can’t work out what this is
exactly. Is it a type of dissociation/shock, depression and
anxiety? Another woman today was screaming and wailing with an
abdominal pain. She has been a frequent attender at the emergency
tent. This is since the earthquake where she lost her parents,
brothers, sisters and cousins.

Another case I saw was an aggressive young man in our emergency
room. What was a most difficult task as a UK psychiatrist was
having to restrain and tie him to the bed with bandages. I was
impressed with how humanely this was done and helped by his mother.
It is an uncomfortable thing to watch when I compare with UK
psychiatry. Here, there was no option at that time.

Training

We continue to roll out our training to health workers in
primary and secondary care. It is a joy to teach such an
appreciative and receptive audience. I’m beginning to really see
how we can make an impact on improving mental health in this region
through our training and participation in clinical work. This is
all thanks to the enthusiasm of our Haiti health hosts.

Still in my tent one month on!

Personal blog written by Dr. Peter Hughes, Psychiatrist working
at International Medical Corps

11.2.2010 Port-au-Prince, Haiti

I write now just over one week into my stay in Haiti. I left
Santo Domingo finally by helicopter with volunteers, almost all
from USA with International Medical Corps. They are medical,
nursing and other staff who have volunteered for 2 week periods of
volunteer work in the main general hospital of Port-au-Prince.

Arriving in Port-au-Prince into a suburban area, and not even an
airport, did not reveal the full extent of the earthquake. The
effect of the earthquake is so sporadic. Buildings here are intact
and then a random, collapsed one. However there does not seem to be
a single street that has not been ravaged by the earthquake. Every
building is a tomb for an unknown number of people.Yet walking
around Port-au -Prince life goes on as normal. But everywhere
people are staying in tents including myself. We don’t know when
the next earthquake or aftershock will arrive.

Local people who have been through the earthquake are petrified to
be indoors. Gradually I see more and more destruction each day. It
is an eerie experience to see building after building reduced to
rubble and all the human life that goes with this. Each day I see
the tensions on the street as people fight, as distribution of food
leads to long queues and frayed tempers.

Every day I pass by the market area which was one of the
largest in the region. It is unclear how many people perished here.
A huge building has collapsed to absolute rubble. Now youths are
scrambling up mounds of rubble to loot any items from the
market.

What I find most poignant, as I think many of us do, is the
school of nursing which is just next to my work base. Here at least
a hundred or more nurses perished in the earthquake. It looks like
complete rubble. I pass this every day. One day they were removing
some bodies. That is a sight that is quite hard to forget and the
smell lingers. Today I saw a load of notebooks nearby on the road
that obviously had come from the nursing school. This is my
strongest image of the earthquake.

My work is based in the Mars and Kline Psychiatry hospital where
they kindly collaborate with us. We are hoping to support their
health systems in the main psychiatric hospital and gradually
spread out through primary care throughout the earthquake affected
region. This hospital holds 100 patients but the majority left
after the earthquake when they were fearful of staying in such a
structure. All the staff have been touched by the earthquake,
losing family, friends and neighbours. Most of the staff are
sleeping on the street still. For example, one of the nurses today
showed me all of her mosquito bites as she is still sleeping
outside with no shelter. Yet they still manage to come to work and
care for the patients.

The inpatients seem to be predominantly suffering from
psychosis. The courtyard for the patients is riven with a long gash
from the earthquake. The perimeter walls have collapsed.
Fortunately no patient was injured in the earthquake. The
outpatient service is tent-based outside. The earthquake has
exposed patients’ vulnerabilities. I saw one man who had lost a son
and his only other offspring, the other son, was paralysed. He had
become manic as a result. Other patients were unable to get their
medications for their psychosis because of the disruption, and have
had a relapse of their symptoms. There is a lot of anxiety amongst
the population, and amongst the mentally ill, particularly in
relation to going into buildings. Many people somatise to chest
pain.

The other area of work is the General Hospital, which is tented
with many USA and other volunteers supporting the Hospital, which
struggles to meet the needs after the earthquake. The majority of
the patients are in tents. There are many amputations. Today I
spoke to a man who was about to have a below knee amputation. Next
to him was a young girl with bilateral below knee amputation.
Friday , Saturday and Sunday are a national day of mourning in this
tented city for the catastrophic loss of life and livelihood. I now
return to my own tent!

2.2.2010 Santo Domingo, The Dominican Republic

As I write, I am currently waiting in Santo Domingo to go by
land to Haiti around 2am. Haiti had a massive earthquake on 12
January 2010. Didn’t think too much of this, but a few days later I
had a call from the International Medical Corps asking me to be
part of a mental health programme, led by Dr Lynn Jones. This aims
to strengthen and develop mental health services after the
earthquake.

From that point it has been hectic trying to organise my travel
and all my arrangements. My employers, South West London and St.
George’s Mental Health NHS trust, have supported me fully in this
endeavour and have released me from my work for this time.

One of my tasks was to try and organise some medical supplies
for Haiti. Support has been incredible. Through fundraising, I
raised over £7000 of donations which has gone into buying
medication which I can take directly to Haiti. Sticking to the
required essential medication list, my three large boxes are packed
with haloperidol, procyclidine, amitryptiline, fluoxetine,
chlorpromazine to name a few. It is important to have a sustainable
medical supply until supplies are re-established.

My journey to Haiti was made smoother when people found out my
destination. Even at Heathrow, I was sped through towards the
plane. In Miami, staff literally blessed me on! It was touching and
certainly helped me get through transit to Santo Domingo. The
flight to the Dominican Republic was full of relief workers; many
were church-based and were from the US.

Santo Domingo - the scale of the earthquake really starts to hit
me. On international development work scales, this has been the
most exhausting, upsetting and personally demanding for those first
on site. The relief effort has been going remarkably well all
things considered. The first wave of emergency relief is coming to
an end and now is heading towards the stage of future sustainable
development.

About this blog

Dr Peter Hughes is a consultant psychiatrist
based at Springfield University Hospital, London. He has an
interest in international psychiatry and has been travelling to
Africa over the last five years doing short-term assignments in
mental health. He has recently flown to Haiti to work on a mental
health programme.